Building A Health Care System: Care Coordination and Integration

The definition of a system is assemblage or combination of things or parts forming a complex or unitary whole. Today’s health care system is a series of parts not yet connected to each other. Improving care coordination and communication while reducing fragmentation weaves these series of parts together to create a more effective health care system. AHCCCS efforts to integrate care delivery systems and properly align incentives are designed to transform the structure of the Medicaid program to improve health outcomes and better manage limited resources.

A Holistic Approach to Health Care: Bringing Together Behavioral and Physical Health for Persons with Serious Mental Illness

In Arizona, behavioral health is a carved out benefit separately managed by Regional Behavioral Health Authorities (RBHAs). As such, a person with a serious mental illness (SMI) could navigate up to four different health care systems to get care – their AHCCCS acute health plan for physical health services; the RBHA for their behavioral health services; Medicare, since many persons with SMI are dually eligible for Medicaid and Medicare; and Medicare Part D for medications. Navigating the health care system is one of the greatest barriers to accessing care. The result for Arizonans with SMI was less than optimal. Concerns around poor medication management and stigma caused many people to forgo physical health care. Because many persons with SMI also experience co-morbidities, management of chronic diseases like diabetes or hypertension was also poor. Learn more about what AHCCCS is doing to integrate care for individuals with SMI

Medicare presents one of the greatest challenges to states serving individuals dually eligible for Medicaid and Medicare. Medicare is its own distinct, complex system of care operated by the federal government with little to no interface with state Medicaid programs. For the over 140,000 Arizonans that are eligible for both Medicare and Medicaid, navigating these two separate systems of care can be overwhelming. Under these circumstances, people fall through the cracks, inefficient care is provided, and optimal health outcomes are not achieved. Learn more about what AHCCCS is doing to bring these two systems together on the Duals page.

Simplifying the System of Care for Children with Special Health Care Needs: Children’s Rehabilitative Services (CRS)

Children’s Rehabilitative Services (CRS) was started in 1929 to serve children with complex health care needs who require specialized services. Services for the treatment of CRS qualifying conditions were previously managed solely through the CRS program. Medicaid members would then have to access routine or other non-CRS specialty physical health care through their AHCCCS acute plan and behavioral health through the RBHA. For children that were Medicare eligible, the family had one additional hurdle. Arizona families attempting to care for their child with special health care needs was being asked to navigate up to four systems of care. Learn more about what AHCCCS is doing to bring these two systems together on the CRS page.

Tribal Coordination and Promising Practices

Arizona is home to over 350,000 American Indians/Alaska Natives (AI/AN), approximately half of whom are enrolled in AHCCCS. Significant health disparities exist for the AI/AN population. For instance, the average age of death for American Indians is 17.5 years younger than the general population, and American Indians experience higher death rates from preventable diseases. Whereas the American Indian population accounts for less than 2% of the national population and 4% of the Arizona population, it accounts for approximately 10% of the AHCCCS population.

Recognizing its unique role in addressing the health needs of Arizona’s AI/AN population, AHCCCS has launched a new effort to improve the health outcomes of tribal members by identifying critical population needs and collaborating with tribes, tribal health partners, community organizations and state and federal agencies to enhance care coordination.Learn more about what AHCCCS is doing on the Promising Practices page.

AHCCCS has partnered with state and county governments to improve coordination within the justice system and create more cost effective and efficient ways to transition people leaving the criminal justice system. A significant number of men, women and children transitioning out of jail and prison into communities are in need of services for behavioral health and physical health conditions. Many of these individuals are eligible for Medicaid.

To facilitate this transition, AHCCCS is engaged with the Arizona Department of Corrections (ADOC) and most Arizona counties covering the majority of the State’s population, including the two largest – Maricopa and Pima – in a data exchange process that allows AHCCCS to suspend eligibility upon incarceration, rather than terminate coverage. This exchange also allows ADOC and counties to electronically send discharge dates, which simplifies the process of transitioning directly into care. Through this enrollment suspension process, care can be coordinated by county jails or prisons upon discharge. To support this, all RBHAs are contractually required to have a justice systems contact that can ensure a connection to needed behavioral health services. In addition, AHCCCS medical management coordinates with counties to facilitate a transition to care into acute health plans for persons being discharged with serious physical illnesses, such as cancer or other illness, that present public health concerns or require immediate attention. More information will be posted soon.